Treatment intervals for use of compositions comprising energy absorbing materials for dermatological applications

ABSTRACT

The present invention provides compositions comprising energy (e.g., light) absorbing submicron particles (e.g., nanoparticles comprising a silica core and a gold shell) and methods for delivering such particles via topical application. This delivery is facilitated by application of mechanical agitation (e.g. massage), acoustic vibration in the range of 10 Hz-20 kHz, ultrasound, alternating suction and pressure, and microjets. The method of treatment is performed and then, depending upon the desired clinical outcome, repeated after a treatment response interval has elapsed.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit or priority under 35 U.S.C. § 119(e)of U.S. Provisional Application Nos. 61/926,063 filed Jan. 10, 2014, theentire contents of which are incorporated herein by this reference.

This application may contain subject matter that is related to thatdisclosed and claimed in U.S. patent application Ser. No. 12/787,655filed May 26, 2010, now U.S. Pat. No. 8,961,450 granted on Feb. 24,2015, the entire contents of which are incorporated herein by thisreference.

INCORPORATION BY REFERENCE

This application also includes subject matter that is related to subjectmatter described in U.S. patent application Ser. No. 13/219,514 filedAug. 26, 2011, now U.S. Pat. No. 9,061,056 granted on Jun. 23, 2915 andU.S. patent application Ser. No. 09/225,026 filed Jan. 4, 1999, now U.S.Pat. No. 6,183,773 granted on Feb. 6, 2001, each of which are alsoincorporated herein in its entirety. All publications and patentapplications mentioned in this specification are herein incorporated byreference in their entirety to the same extent as if each individualpublication or patent application was specifically and individuallyindicated to be incorporated by reference.

FIELD

This application relates to the timing of subsequent therapy in a lightbased therapy method.

BACKGROUND

Acne vulgaris is a follicular skin disease that is characterized by theappearance of comedones, papules, nodules, and cysts. Comedones are hairfollicles that are blocked with a keratin plug. Open comedones, those inwhich the keratin plug is visible, form “black heads” and closedcomedones form “whiteheads” that often progress to inflamed papules,nodules, and cysts. The presence of bacteria in a follicle attractswhite blood cells to the follicle, which can cause an inflammatoryresponse seen as papules (red bumps), pustules, and nodules. Acne may beminor, where only a few comedones or papules are present, or it may behighly inflammatory and leave disfiguring scars. Improved methods oftreating or ameliorating follicular skin diseases, such as acnevulgaris, are required.

The mechanism of one type of treatment described herein is throughdelivery of light absorbing particles in to the sebaceous folliclesselectively followed by pulsed laser irradiation that causes selectiveheating. Cell death occurs primarily due to heat fixation or proteindenaturation though some occurs via apoptosis and accidental cell death.It is desired to achieve a high level of injury in one single treatmentbut without collateral damage and side effects. Due to various reasonsincluding limited delivery of the particles possible in one treatment,the injury is limited and may not lead to complete resolution of acne.

While a single treatment may be a complete treatment, there may bepatients or treatment scenarios that would benefit from two or moretreatments delivered in such a way as to further enhance the clinicaloutcome.

SUMMARY OF THE DISCLOSURE

As described below, the present invention provides methods for treatingor ameliorating follicular skin diseases (e.g., acne) in a subject(e.g., a human) and compositions comprising energy (e.g., light)absorbing submicron particles (e.g., nanoparticles comprising a silicacore and a gold shell) and methods for delivering such particles viatopical application into, e.g., a hair follicle, sebaceous duct, and/orsebaceous gland, for use in accordance with those methods.

Thus, in one aspect, the invention provides a method of treating orameliorating a follicular skin disease in a subject, the methodcomprising: topically applying a formulation comprising sub-micronparticles comprising a light absorbing material to the subject's skin;facilitating delivery of the material into a hair follicle, sebaceousgland, sebaceous gland duct, or infundibulum of the skin by mechanicalagitation, acoustic vibration, ultrasound, alternating suction andpressure, or microjets; and exposing the sub-micron particles to energyactivation, thereby treating or ameliorating the follicular skin diseasein the subject.

In another aspect, the invention provides a method of improving theappearance of enlarged pores in the skin of a subject, the methodcomprising: topically applying a formulation comprising sub-micronparticles comprising a light absorbing materials to the subject's skin;facilitating delivery of the materials to a hair follicle, sebaceousgland, sebaceous gland duct, or infundibulum of the skin by mechanicalagitation, acoustic vibration, ultrasound, alternating suction andpressure, or microjets; and exposing the sub-micron particles to energyactivation, thereby improving the appearance of enlarged pores in theskin of the subject.

In yet another aspect, the invention provides a method of improving theappearance of oily skin of a subject, the method comprising: topicallyapplying a formulation comprising sub-micron particles comprising alight absorbing materials to the subject's skin; facilitating deliveryof the sub-micron particles to a hair follicle, sebaceous gland,sebaceous gland duct, or infundibulum of the skin by mechanicalagitation, acoustic vibration, ultrasound, alternating suction andpressure, or microjets; and exposing the sub-micron particles to energyactivation, thereby improving the appearance of oily skin of thesubject.

Another aspect of the invention provides a method for permanentlyremoving hair of a subject, the method comprising: topically applying alight-absorbing material to the skin of the subject, and exposing thematerial to energy activation, thereby permanently removing the hair. Inone embodiment, the hair is lightly pigmented or thin hair. In anotherembodiment, the method further comprises epilating hair from thefollicle of the subject before topically applying the light-absorbingmaterial to the skin of the subject and exposing the material to energyactivation.

In another aspect, the invention provides a method for treatinghyperhidrosis by thermally damaging eccrine glands or their surroundingarea, the method comprising: topically applying a light-absorbingmaterial to the skin of a subject, and exposing the material to energyactivation, thereby permanently removing the glands and treatinghyperhidrosis.

In yet another aspect, the invention provides a method of facilitatingdelivery of a light absorbing material to a target volume within theskin of a subject to achieve a therapeutic effect, the methodcomprising: topically applying a formulation comprising a lightabsorbing material to a subject's skin to deliver the material to areservoir within the skin; facilitating delivery of the material to atarget volume within the skin of the subject by irradiating the skinwith a first series of light pulses; and exposing the light absorbingmaterial to a second series of light pulses to heat the material andthermally damage the target volume to achieve a therapeutic effect.

In still another aspect, the invention provides a method of facilitatingdelivery of a light absorbing material to a target volume within theskin of a subject to achieve a therapeutic effect, the methodcomprising: topically applying a formulation comprising a lightabsorbing material to a subject's skin; facilitating delivery of thematerial to a reservoir in the skin by mechanical agitation;facilitating delivery of the material to a target volume within the skinby applying a train of low-energy laser pulses each pulse lasting for amicrosecond or less to drive the material into the target volume; andexposing the light absorbing material to a second series of low-energylaser pulses to heat the material and thermally damage the target volumeto achieve a therapeutic effect.

Still another aspect of the invention provides a method of treating orameliorating a follicular skin disease of a subject, the methodcomprising: topically applying a formulation comprising a sub-micronparticle comprising a light absorbing material to a subject's skin;facilitating delivery of the material from the skin into a hair follicleby acoustically created microjets in the formulation; and exposing thesub-micron particle to energy activation, thereby treating thefollicular skin disease.

In yet another aspect, the invention provides a method of treating orameliorating a follicular skin disease of a subject, the methodcomprising: exposing the subject's skin to a formulation comprisingsub-micron particles comprising a light absorbing material; andfacilitating delivery of the material from the skin into a hair follicleby low frequency ultrasound induced cavitation within the formulationnear the surface of the skin adjacent to the hair follicle; and exposingthe sub-micron particles to energy activation, thereby treating thefollicular skin disease.

Still another aspect of the invention provides a method of facilitatingdelivery of a light absorbing material to a target volume within theskin of a subject, the method comprising: topically applying aformulation comprising a light absorbing material to a subject's skin todeliver the material to a reservoir within the target volume of theskin; facilitating delivery of the material to a target volume withinthe skin of the subject substantially via a transfollicular pathway; andexposing the light absorbing material to a series of light pulses toheat the material and thermally damage the target volume to achieve atherapeutic effect.

In another aspect, the invention provides a method of treating orameliorating a follicular skin disease of a subject, the methodcomprising: topically applying a formulation comprising particles of alight absorbing material to a subject's skin; acoustically cavitatingthe formulation for selectively facilitating delivery of the particlesin the formulation into a sebaceous gland primarily through thecorresponding hair follicle; and irradiating the particles with light totreat the follicular skin disease.

Another aspect of the invention provides a method of treating orameliorating a follicular skin disease of a subject, the methodcomprising: topically applying a formulation comprising sub-micronparticles comprising a light absorbing material to a subject's skin;delivering the formulation into one or more sebaceous glandssubstantially via a transfollicular pathway; and exposing the sub-micronparticles to energy activation, thereby treating the follicular skindisease.

Still another aspect of the invention provides a method of treating orameliorating a follicular skin disease of a subject, the methodcomprising: topically applying a formulation comprising a sub-micronparticle comprising a light absorbing material to a subject's skin;facilitating delivery of the material into a hair follicle by lowfrequency ultrasound induced cavitation near the surface of the skinadjacent to the hair follicle; and treating or ameliorating thefollicular skin disease adjacent to the sub-micron particle using heatproduced by irradiating the sub-micron particle with light.

The above-described method aspects of the invention or other aspects ofthe invention described herein include a plurality of useful embodimentsthat are universally applicable to the methods of the inventiondescribed herein.

Thus, in one embodiment, delivery of the light absorbing material into,e.g., the hair follicle, is facilitated by ultrasound-created microjetswithin the formulation.

In another embodiment, the sub-micron particles to energy activationcomprises irradiating the sub-micron particle with light, therebyheating the particle.

In another embodiment, the sub-micron particles are within a sebaceousgland during irradiation. In one embodiment, the sub-micron particlesare substantially completely within the sebaceous gland duringirradiation. In another embodiment, the sub-micron particles are withina sebaceous gland duct during irradiation. In yet another embodiment,the sub-micron particles are substantially completely within thesebaceous gland duct during irradiation. In still another embodiment,the sub-micron particles are within an infundibulum involved in thefollicular skin disease.

In certain embodiments, the light absorbing material in the formulationcomprises a photoactive compound, photodynamic therapy (PDT) pro-drug orPDT drug.

In one embodiment, the application of ultrasound is at a frequency inthe range of 20 kHz to 500 kHz. In another embodiment, the applicationof ultrasound is at a frequency in the range of 20 kHz to 100 kHz. Inyet another embodiment, the application of ultrasound is at a frequencyin the range of 20 kHz to 60 kHz. In still another embodiment, theapplication of ultrasound energy is at a frequency in the range of 30kHz to 50 kHz.

In one embodiment, the ultrasound power density is from about 0.5-50W/cm2. In another embodiment, the ultrasound horn face peak-to-peakamplitude displacement is in the range of 0.5 to 30 microns.

In certain embodiments, the particles or light absorbing materials aresized to enter into and along a follicle pore. In one embodiment, theparticles are sized from about 1 micron to about 5 microns. In anotherembodiment, the particles are between about 50 nm about 250 nm indiameter. In yet another embodiment, the particles are nanoshells.

In certain other embodiments, the sizes of sub-micron particlesaccording to the invention are selected for passage through the hairfollicle and into a sebaceous gland of the hair follicle. In oneembodiment, the hair follicle is a terminal follicle. In anotherembodiment, the hair follicle is a vellus follicle. In yet anotherembodiment, the hair follicle is a sebaceous follicle.

In one embodiment, the sub-micron particle size is between about 0.01microns to about 1.0 microns. In another embodiment, the sub-micronparticle size is between about 0.05 to about 0.25 microns.

In one embodiment, the facilitating step further comprises selectingcharacteristics for the ultrasound-created microjets to create bubblesin the formulation about the same size as the hair follicle pore. Inanother embodiment, the facilitating step further comprises selectingcharacteristics for low frequency ultrasound induced cavitation forcreating bubbles in the formulation about the same size as the hairfollicle.

In other embodiments, the ultrasound-created microjets in theformulation are within about 50 microns to about 100 microns of thesurface of the skin of the subject.

In certain embodiments, delivery of the light absorbing matter isfacilitated by an immersion cavitation step. In one embodiment, thefacilitating step produces cavitation within about 50-100 microns of thesurface of the skin. In another embodiment, the portion of the stratumcorneum of the portion of the subject's skin exposed to the deliverystep remains intact In certain other embodiments, delivery, e.g.,substantially via a transfollicular pathway, of the light absorbingmaterial into, e.g., one or more sebaceous glands or hair follicles, isfacilitated by low frequency ultrasound induced cavitation near thesurface of the skin adjacent to the hair follicle. In one embodiment,the induced cavitation is between about 50 microns to about 100 micronsfrom the surface of the skin. In another embodiment, the characteristicsof the low frequency ultrasound are selected such that the inducedcavitation near the surface of the skin leaves the stratum corneumintact.

In one embodiment, the follicular disease for treatment ishyperhidrosis. In certain embodiments, the facilitating step deliversparticles into an eccrine gland via the eccrine gland duct.

In other embodiments, the follicular disease for treatment is acnevulagris. In yet other embodiments, the follicular disease for treatmentis sebaceous hyperplasia In still other embodiments, the folliculardisease for treatment is hirsuteness.

In one embodiment, the sub-micron particles are coated with PEG. Inanother embodiment the particles have an absorption peaked between 700and 1,100 nm wavelength of light. In another embodiment, the sub-micronparticles have a ratio of the shell diameter to the core diameterbetween about 1.05 to about 2.0.

In another embodiment, the sub-micron particle is a nanoparticle ornanoshell. In certain embodiments, the nanoparticle or nanoshell has adiameter of about 50 to about 300 nm (e.g., 50, 75, 100, 125, 150, 175,200, 250, 300 nm). In one embodiment, the nanoparticle or nanoshell hasa diameter of about 50 to about 250 nm. In another embodiment, thenanoparticle has a diameter of about 150 nm.

In another embodiment, the nanoparticle is coated with PEG.

In yet another embodiment, the nanoparticle is a nanoshell. In certainembodiments, the nanoparticle comprises a silica core and a gold shell.

In certain embodiments, the sub-micron particles comprise from about0.5% to about 2% of the formulation. In one embodiment, the formulationcomprises about 0.5 to about 2% of a suspension comprisingnanoparticles. In another embodiment, the formulation comprises about0.1 to about 10% of a suspension comprising nanoparticles.

In one embodiment, the formulation contains a surfactant and/or ishydrophilic. In another embodiment, the formulation contains asurfactant and/or is lipophilic. In yet another embodiment, theformulation contains a surfactant and/or is liposomal. In certainembodiments, the surfactant is less than 10% of the formulation.

In certain embodiments, the formulation comprises a component havingability to solubilize lipids. In one embodiment, the component isethanol.

In one embodiment, the formulation comprises one or more of ethanol,isopropyl alcohol, propylene glycol, a surfactant, and/or isopropyladipate. In another embodiment, the formulation compriseshydroxypropylcellulose (HPC) and carboxymethyl cellulose (CMC). In stillanother embodiment, the formulation comprises any one or more of water,ethanol, propylene glycol, polysorbate 80, diisopropyl adipate,phospholipon, and thickening agents.

In certain embodiments, the formulation has an optical density ofbetween 5-500. In one embodiment, the formulation has an optical densityof about 75. In another embodiment, the formulation has an opticaldensity of about 125. In another embodiment, the formulation has anoptical density of about 250.

In certain embodiments, energy activation, e.g., light activation, isaccomplished with a pulsed laser light that delivers light energy at awavelength that is absorbed by the particle. In one embodiment, thepulsed laser light delivers light energy at a wavelength that ispreferentially absorbed by the particle. In another embodiment, energyactivation is accomplished with a continuous laser that delivers lightenergy at a wavelength that is absorbed by the particle

In one embodiment, the light energy has a wavelength range from about700 to about 1,100 nm. In another embodiment, the light energy has afluence of less than about 100 J/cm². In still another embodiment, thelight energy has a pulse duration of from about 0.5 ms-1,000 ms.

In certain embodiments, the skin is prepared for the method by heating,by removing the follicular contents, and/or by epilation. In oneembodiment, the follicular contents are removed by a method comprisingcontacting the follicle pore with adhesive polymers.

In certain other embodiments, the topically applied sub-micron particlesare wiped from the skin prior to energy activation. In one embodiment,the topically applied sub-micron particles are wiped from the skin withthe aid of a fluid, prior to application of optical radiation. Inanother embodiment, the fluid is water, ethanol or acetone. In anotherembodiment, the fluid can be comprised of one or more of water,solvents, surfactants, alcohols.

In certain other embodiments, the skin is heated before, during, orafter topical application to a temperature sufficient to assist infollicular delivery. In one embodiment, the heating is accomplished viaultrasound. In another embodiment, the heating is accomplished viasteam. In yet another embodiment, the heating is accomplished via hotpacks. In still another embodiment, heating is accomplished via hottowels. In general, the heating is not sufficient to cause pain, tissuedamage, burns, or other heat-related effects in the skin. In oneembodiment, the temperature is about 35-44° C. In another embodiment,the temperature is about 40-44° C. In yet another embodiment, thetemperature is about 42° C.

In certain embodiments, the step of exposing further comprises placing avolume of the formulation in a container so that the formulation is incontact with the subject's skin. In one embodiment, the step offacilitating further comprises placing an ultrasound applicator into thecontainer and immersed in the formulation.

In one embodiment, the target volume is the sebaceous gland, the targetvolume is within the follicle beneath the skin.

In another aspect, the invention provides a composition comprising acosmetically acceptable carrier and a plurality of plasmonicnanoparticles in an amount effective to induce thermomodulation in atarget tissue region with which the composition is topically contacted.

In one embodiment, the plasmonic nanoparticles are activated by exposureto energy delivered from a nonlinear excitation surface plasmonresonance source to the target tissue region. In another embodiment, theplasmonic nanoparticle comprises a metal, metallic composite, metaloxide, metallic salt, electric conductor, electric superconductor,electric semiconductor, dielectric, quantum dot or composite from acombination thereof. In yet another embodiment, a substantial amount ofthe plasmonic particles present in the composition comprisegeometrically-tuned nanostructures.

In one embodiment, the plasmonic particles comprise any geometric shapecurrently known or to be created that absorb light and generate plasmonresonance at a desired wavelength, including nanoplates, solidnanoshells, hollow nanoshells, nanorods, nanorice, nanospheres,nanofibers, nanowires, nanopyramids, nanoprisms, nanostars or acombination thereof. In another embodiment, the plasmonic particlescomprise silver, gold, nickel, copper, titanium, silicon, galadium,palladium, platinum, or chromium.

In one embodiment, the cosmetically acceptable carrier comprises anadditive, a colorant, an emulsifier, a fragrance, a humectant, apolymerizable monomer, a stabilizer, a solvent, or a surfactant. In oneparticular embodiment, the surfactant is selected from the groupconsisting of sodium laureth 2-sulfate, sodium dodecyl sulfate, ammoniumlauryl sulfate, sodium octech-1/deceth-1 sulfate, lipids, proteins,peptides or derivatives thereof. In another specific embodiment thesurfactant is present in the composition in an amount between about 0.1and about 10.0% weight-to-weight of the carrier.

In one embodiment, the solvent is selected from the group consisting ofwater, propylene glycol, alcohol, hydrocarbon, chloroform, acid, base,acetone, diethyl-ether, dimethyl sulfoxide, dimethylformamide,acetonitrile, tetrahydrofuran, dichloromethane, and ethylacetate.

In another embodiment, the composition comprises plasmonic particlesthat have an optical density of at least about 1 O.D. at one or morepeak resonance wavelengths.

In yet another embodiment, the plasmonic particles comprise ahydrophilic or aliphatic coating, wherein the coating does notsubstantially adsorb to skin of a mammalian subject, and wherein thecoating comprises polyethylene glycol, silica, silica-oxide,polyvinylpyrrolidone, polystyrene, a protein or a peptide.

In one embodiment, the thermomodulation comprises damage, ablation,lysis, denaturation, deactivation, activation, induction ofinflammation, activation of heat shock proteins, perturbation ofcell-signaling or disruption to the cell microenvironment in the targettissue region.

In another embodiment, the target tissue region comprises a sebaceousgland, a component of a sebaceous gland, a sebocyte, a component of asebocyte, sebum, or hair follicle infundibulum.

In a specific embodiment, the target tissue region comprises a bulge, abulb, a stem cell, a stem cell niche, a dermal papilla, a cortex, acuticle, a hair sheath, a medulla, a pylori muscle, a Huxley layer, or aHenle layer.

In another aspect, the invention provides a method for performingtargeted ablation of a tissue to treat a mammalian subject in needthereof, comprising the steps of i) topically administering to a skinsurface of the subject a composition of the invention as describedabove; ii) providing penetration means to redistribute the plasmonicparticles from the skin surface to a component of dermal tissue; andiii) causing irradiation of the skin surface by light.

In one embodiment, the light source comprises excitation of mercury,xenon, deuterium, or a metal-halide, phosphorescence, incandescence,luminescence, light emitting diode, or sunlight.

In another embodiment, the penetration means comprises high frequencyultrasound, low frequency ultrasound, massage, iontophoresis, highpressure air flow, high pressure liquid flow, vacuum, pre-treatment withfractionated photothermolysis or dermabrasion, or a combination thereof.

In yet another embodiment, the irradiation comprises light having awavelength of light between about 200 nm and about 10,000 nm, a fluenceof about 1 to about 100 joules/cm², a pulse width of about 1 femtosecondto about 1 second, and a repetition frequency of about 1 Hz to about 1THz.

In another aspect, the invention provides a composition comprising acosmetically acceptable carrier, an effective amount of sodium dodecylsulfate, and a plurality of plasmonic nanoparticles in an amounteffective to induce thermal damage in a target tissue region with whichthe composition is topically contacted, wherein the nanoparticles havean optical density of at least about 1 O.D. at a resonance wavelength ofabout 810 nanometers or 1064 nanometers, wherein the plasmonic particlescomprise a silica coating from about 5 to about 35 nanometers, whereinthe acceptable carrier comprises water and propylene glycol.

In still another aspect, the invention provides a system for laserablation of hair or treatment of acne comprising a composition of theinvention as described above and a source of plasmonic energy suitablefor application to the human skin.

The desired effects from selective photothermolysis of sebaceous glandsusing one or a combination of the above can be enhanced by choosing anoptimal treatment interval. In one aspect, the treatment interval isselected by re-treating cells and tissue when they are most vulnerableto repeated thermal injury. In one aspect, the second or subsequenttreatment occurs one, two, three, four, five or six days after theinitial or just prior treatment. In one aspect, the interval betweensecond and subsequent or the just prior treatment is the same or,optionally, different. In one aspect, the timing between second orsubsequent treatment is during a window of 4-14 days since the lasttreatment.

The invention provides compositions, methods and systems for treatingfollicular skin diseases during a single treatment or using two or moretreatments at a desired treatment interval. Compositions and articlesdefined by the invention were isolated or otherwise manufactured inconnection with the examples provided below. Other features andadvantages of the invention will be apparent from the detaileddescription, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a micrograph showing thermal damage to the follicularepithelium and part of the sebaceous gland following delivery of ananoshell suspension by massage.

FIG. 2 is a photograph showing the skin surface after application of thenanoshell formulation with ultrasound facilitated delivery. Excessformulation was wiped from the skin before this photograph was taken.

FIG. 3 is a micrograph showing a follicle filled with dark colorednanoshells following ultrasound facilitated delivery. No nanoshells arenoted in the epidermis or the dermis.

FIG. 4 is a micrograph showing a hair follicle and surrounding skinafter ultrasound delivery of nanoshells and laser irradiation visualizedby hematoxylin and eosin (H&E stain). Selective thermal damage aroundthe follicle is shown by the added black delineation.

FIG. 5 is a photograph showing the skin surface. Accumulation ofnanoshells in the follicles is seen.

FIG. 6 is a micrograph showing a follicle having a significantaccumulation of nanoshells.

FIG. 7 is a micrograph showing localized thermal damage to a follicleencompassing the sebaceous gland visualized using H&E stain.

FIG. 8 is a table showing the efficacy of nanoshell delivery followed bylaser treatment in a human clinical trial of back acne.

FIG. 9 illustrates in a general way the biologic response of cells andtissue to thermal injury as a function of time since thermal injuryoccurred.

FIG. 10 is a flow chart of an exemplary method of providing therapybased on a desired response interval.

DETAILED DESCRIPTION

The invention features compositions comprising light/energy absorbingmaterials and methods that are useful for their topical delivery to atarget (e.g., a follicle, follicular infundibulum, sebaceous gland) forthe treatment of a follicular disease.

Definitions

Unless defined otherwise, all technical and scientific terms used hereinhave the meaning commonly understood by a person skilled in the art towhich this invention belongs. The following references provide one ofskill with a general definition of many of the terms used in thisinvention: Singleton et al., Dictionary of Microbiology and MolecularBiology (2nd ed. 1994); The Cambridge Dictionary of Science andTechnology (Walker ed., 1988); The Glossary of Genetics, 5th Ed., R.Rieger et al. (eds.), Springer Verlag (1991); and Hale & Marham, TheHarper Collins Dictionary of Biology (1991). As used herein, thefollowing terms have the meanings ascribed to them below, unlessspecified otherwise.

By “ameliorate” is meant decrease, suppress, attenuate, diminish,arrest, or stabilize the development or progression of a skin disease orcondition. One exemplary skin condition is acne vulgaris

The terms “compounds” and “materials” are used interchangeably and referto o active moieties in accordance with the invention.

In this disclosure, “comprises,” “comprising,” “containing” and “having”and the like can have the meaning ascribed to them in U.S. patent lawand can mean “includes,” “including,” and the like; “consistingessentially of” or “consists essentially” likewise has the meaningascribed in U.S. patent law and the term is open-ended, allowing for thepresence of more than that which is recited so long as basic or novelcharacteristics of that which is recited is not changed by the presenceof more than that which is recited, but excludes prior art embodiments.

“Detect” refers to identifying the presence, absence or amount of theanalyte to be detected.

By “effective amount” is meant the amount of a required to amelioratethe symptoms of a disease relative to an untreated patient. Theeffective amount of active compound(s) used to practice the presentinvention for therapeutic treatment of a disease varies depending uponthe manner of administration, the age, body weight, and general healthof the subject. Ultimately, the attending physician or veterinarian willdecide the appropriate amount and dosage regimen. Such amount isreferred to as an “effective” amount.

By “energy activation” is meant stimulation by an energy source thatcauses thermal or chemical activity. Energy activation may be by anyenergy source known in the art. Exemplary energy sources include alaser, ultrasound, acoustic source, flashlamp, ultraviolet light, anelectromagnetic source, microwaves, or infrared light. An energyabsorbing material absorbs the energy and become thermally or chemicallyactive.

The terms “light”, “light energy”, “optical energy” and “opticalradiation” are used interchangeable herein.

As used herein, “obtaining” as in “obtaining an agent” includessynthesizing, purchasing, or otherwise acquiring the agent.

The phrase “pharmaceutically acceptable carrier” as used herein means apharmaceutically acceptable material, composition or vehicle, such as aliquid or solid filler, diluent, excipient, solvent or encapsulatingmaterial, involved in carrying or transporting an energy activatablematerial of the present invention within or to the subject such that itcan performs its intended function. Each carrier must be “acceptable” inthe sense of being compatible with the other ingredients of theformulation and not injurious to the patient. Some examples of materialswhich can serve as pharmaceutically acceptable carriers include: sugars,such as lactose, glucose and sucrose; starches, such as corn starch andpotato starch; cellulose, and its derivatives, such as sodiumcarboxymethyl cellulose, ethyl cellulose and cellulose acetate; powderedtragacanth; malt; gelatin; talc; excipients, such as cocoa butter andsuppository waxes; oils, such as peanut oil, cottonseed oil, saffloweroil, sesame oil, olive oil, corn oil and soybean oil; glycols, such aspropylene glycol; polyols, such as glycerin, sorbitol, mannitol andpolyethylene glycol; esters, such as ethyl oleate and ethyl laurate;agar; buffering agents, such as magnesium hydroxide and aluminumhydroxide; alginic acid; pyrogen-free water; isotonic saline; Ringer'ssolution; ethyl alcohol; phosphate buffer solutions; and other non-toxiccompatible substances employed in pharmaceutical formulations. Preferredcarriers include those which are capable of entering a pore by surfaceaction and solvent transport such that the energy activatable materialis carried into or about the pore, e.g., into the sebaceous gland, tothe plug, into the infundibulum and/or into the sebaceous gland andinfundibulum.

By “reduces” is meant a negative alteration of at least 10%, 25%, 50%,75%, or 100%.

By “reference” is meant a standard or control condition.

By “subject” is meant a mammal, including, but not limited to, a humanor non-human mammal, such as a bovine, equine, canine, ovine, or feline.

Ranges provided herein are understood to be shorthand for all of thevalues within the range. For example, a range of 1 to 50 is understoodto include any number, combination of numbers, or sub-range from thegroup consisting 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16,17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34,35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, or 50.

As used herein, the terms “treat,” treating,” “treatment,” and the likerefer to reducing or ameliorating a disorder and/or symptoms associatedtherewith. It will be appreciated that, although not precluded, treatinga disorder or condition does not require that the disorder, condition orsymptoms associated therewith be completely eliminated.

Unless specifically stated or obvious from context, as used herein, theterm “or” is understood to be inclusive. Unless specifically stated orobvious from context, as used herein, the terms “a”, “an”, and “the” areunderstood to be singular or plural.

Unless specifically stated or obvious from context, as used herein, theterm “about” is understood as within a range of normal tolerance in theart, for example within 2 standard deviations of the mean. About can beunderstood as within 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%,0.1%, 0.05%, or 0.01% of the stated value. Unless otherwise clear fromcontext, all numerical values provided herein are modified by the termabout.

The recitation of a listing of chemical groups in any definition of avariable herein includes definitions of that variable as any singlegroup or combination of listed groups. The recitation of an embodimentfor a variable or aspect herein includes that embodiment as any singleembodiment or in combination with any other embodiments or portionsthereof.

Any compositions or methods provided herein can be combined with one ormore of any of the other compositions and methods provided herein.

Follicular Disease Pathogenesis

Sebaceous glands are components of the pilosebaceous unit. They arelocated throughout the body, especially on the face and upper trunk, andproduce sebum, a lipid-rich secretion that coats the hair and theepidermal surface. Sebaceous glands are involved in the pathogenesis ofseveral diseases, the most frequent one being acne vulgaris. Acne is amultifactorial disease characterized by the occlusion of follicles byplugs made out of abnormally shed keratinocytes of the infundibulum(upper portion of the hair follicle) in the setting of excess sebumproduction by hyperactive sebaceous glands.

The infundibulum is an important site in the pathogenesis of manyfollicular diseases (e.g., acne). There is evidence that abnormalproliferation and desquamation of infundibular keratinocytes leads tothe formation of microcomedones and, subsequently, to clinically visiblefollicular “plugs” or comedones. Because the architecture of theinfundibulum is important in the pathogenesis of acne, the selectivedestruction of this portion of the follicle through energy activatablematerial-assisted energy, e.g., laser, targeting eliminates or reducesthe site of pathology.

Topical Delivery of Light/Energy Absorbing Materials

The invention provides delivery of light/energy absorbing materials viatopical application into skin appendages of the follicle, specificallyfollicular infundibulum and the sebaceous gland. In one embodiment, suchmaterials are useful for the treatment of follicular diseases, such asacne (e.g., acne vulgaris), hyperhidrosis. The introduction of energyactivatable materials in sebaceous glands followed by exposure to energy(light) with a wavelength that corresponds to the absorption peak of thechromophore will increase the local absorption of light in tissue andlead to selective thermal damage of sebaceous glands.

In another aspect, there is a treating of hyperhidrosis by thermallydamaging eccrine glands or their surrounding area by applying alight-absorbing material to the skin of a subject, facilitating deliveryinto an eccrine gland via the eccrine gland duct and exposing saidmaterial to energy activation. The method thereby permanently removesthe glands. In one aspect, the method of treating a follicular diseaseis for treatment of hyperhidrosis.

Skin Preparation

If desired, the skin is prepared by one or a combination of thefollowing methods. Delivery of light absorbing materials may befacilitated by epilation of hair, which is performed prior to topicalapplication of the light absorbing materials.

Optionally, the skin is degreased prior to application of the lightabsorbing compounds. For example, acetone wipes are used prior toapplication of sebashells to degrease the skin, especially to remove thesebum and follicular contents.

For certain subjects, delivery may be facilitated by reducing orclearing clogged follicles prior to application of the light absorbingmaterial. Such clearing can enhance the delivery of the plasmonicnanoshells. The follicles, especially in acne prone patients, areclogged by shed keratinocytes, sebum, and bacteria P. acnes. Thefollicle can be emptied by application of vacuum. Other methods arecyanoacrylate stripping, strips with components such as Polyquaternium37 (e.g., BIORE pore removal strips). The polymers flow into thefollicle and dry over time. When the dry polymer film is pulled out, thefollicular contents are pulled out, emptying the follicle.

Optionally, the skin may be heated prior to application of the lightabsorbing materials. Heating reduces the viscosity of the sebum and mayliquefy components of the sebum. This can facilitate delivery of lightabsorbing materials (e.g., formulated as nanoshells) to the follicle.

Topical Delivery of Light Absorbing Materials

Light absorbing materials, such as non-toxic dyes (e.g., indocyaninegreen or methyelene blue) are topically applied to the skin followingany desired preparation. The topically applied formulations containingthe light absorbing materials may comprise ethanol, propylene glycol,surfactants, and acetone. Such additional components facilitate deliveryinto the follicle.

Delivery of light absorbing materials is facilitated by application ofmechanical agitation, such as massage, acoustic vibration in the rangeof 10 Hz-20 kHz, ultrasound, alternating suction and pressure, and jets.In one embodiment, light absorbing materials are delivered asnanoparticles, such as nanoshells or nanorods that absorb light in thevisible and the near-IR region of the electromagnetic spectrum. Inanother embodiment, light absorbing materials are quantum dots.Preferably, the light absorbing materials are formulated for topicaldelivery in a form that facilitates follicular delivery. In oneembodiment, such formulations comprise water, ethanol, isopropylalcohol, propylene glycol, surfactants, and isopropyl adipate andrelated compounds. In one embodiment, the formulation is hydrophilic andcontains a surfactant. In another embodiment, the formulation islipophilic and contains a surfactant. In still another embodiment, thecomposition is liposomal and contains a surfactant. In any of the aboveembodiments, the surfactant is less than 10% of the formulation. Inanother embodiment, the formulation is hydrophilic. In still anotherembodiment, the formulation is lipophilic. In still another embodiment,composition is liposomal.

Ultrasound Facilitated Delivery

Ultrasound has been used to achieve transdermal delivery of compoundsinto the body. Ultrasound appears to generate shock-waves and micro-jetsresulting from bubble cavitation that causes the formation of channelsin the skin, which provide for the transport of molecules of interest.Previous efforts have been directed toward the delivery of the compoundsthrough the stratum corneum. Small molecules, for example, with sizesless than 5 nm, can be delivered through the stratum corneum. Thedelivery rate through the stratum corneum goes down significantly asparticle size increases. For example, for particles with size of 50 nmand higher, the delivery rate through the stratum corneum is very low.However, this size is still much smaller than the pore opening and theinfundibulum of a follicle. For example, 150 nm size silica-core andgold shell structures are being used that are much smaller than theinfundibular diameter while showing low deposition in skin through thestratum corneum.

These findings provide the basis of acne treatment in which theinfundibulo-sebaceous unit is selectively targeted for first delivery oflight absorbing material of appropriate size and then selective thermaldamage to the unit with pulsed laser irradiation. Here, ultrasoundspecifically facilitates the delivery of a light absorbing material intothe follicular structure. The shock waves, microjet formation, andstreaming deliver the light absorbing particles into the follicularinfundibulum and the associated sebaceous gland duct and the sebaceousgland.

Ultrasound is often be accompanied by heating of the target organ, skin.Some heating, for example, up to about 42° C. may help in folliculardelivery. However, excessive heating is undesirable, causing pain,tissue damage, and burns. In one embodiment, excessive heating can beavoided by cooling the skin, for example. In another embodiment, thetopically applied formulation or a coupling gel can be pre- orparallel-cooled. A low duty cycle with repeated ultrasound pulse burstscan also be used to avoid excessive heating, where during the off-time,the body cools the skin that is being subjected to ultrasound energy.

In certain embodiments, the invention provides two methods of ultrasounddelivery are suggested. One is “contact ultrasound” and another is“immersion ultrasound”.

In accordance with an embodiment of the contact ultrasound method, aformulation of the invention is topically applied to the skin byspreading into a thin layer and a horn vibrating at an ultrasoundfrequency is brought into close contact with the formulation-coveredskin.

In accordance with an embodiment of the immersion ultrasound method, areservoir filled with the formulation is placed on top of the skin, ahorn is immersed in it without the horn touching the skin at a distanceranging from about 2 mm to about 30 mm, and the horn is then vibrated atultrasound frequency.

Acoustic cavitation is often an effect observed with ultrasound inliquids. In acoustic cavitation, a sound wave imposes a sinusoidallyvarying pressure upon existing cavities in solution. During the negativepressure cycle, the liquid is pulled apart at ‘weak spots’. Such weakspots can be either pre-existing bubbles or solid nucleation sites. Inone embodiment, a bubble is formed which grows until it reaches acritical size known as its resonance size (Leong et al., AcousticsAustralia, 2011—acoustics.asn.au, THE FUNDAMENTALS OF POWER ULTRASOUND—AREVIEW, p 54-63). According to Mitragotri (Biophys J. 2003; 85(6):3502-3512), the spherical collapse of bubbles yields high pressure coresthat emit shock waves with amplitudes exceeding 10 kbar (Pecha andGompf, Phys. Rev. Lett. 2000; 84:1328-1330). Also, an asphericalcollapse of bubbles near boundaries, such as skin yields microjets withvelocities on the order of 100 m/s (Popinet and Zaleski, 2002; J. Fluid.Mech. 464:137-163). Such bubble-collapse phenomena can assist indelivery of materials into skin appendages, such as hair and sebaceousfollicles. Thus, various embodiments of the invention provide forimmersion ultrasound methods for optimizing bubble size before collapseto promote efficient delivery of light absorbing materials into theintended target (e.g., sebaceous glands, hair follicles).

The resonance size of the bubble depends on the frequency used togenerate the bubble. A simple, approximate relation between resonanceand bubble diameter is given by F (in Hz).times.D (in m)=6 mHz, where Fis the frequency in Hz and D is the bubble diameter (size) in m. Inpractice, the diameter is usually smaller than the diameter predicted bythis equation due to the nonlinear nature of the bubble pulsation.

Table 1 below gives the size of the resonance size of the bubble as afunction of frequency, calculated from the above relationship.

TABLE 1 F, kHz 10 20 30 40 50 100 200 300 400 500 1,000 D_microns 600300 200 150 120 60 30 20 15 12 6

Computer simulations of bubble oscillations give more accurate estimatesof the bubble size. For example, in work by Yasui (J. Acoust. Soc. Am.2002; 112: 1405-1413), three frequencies were investigated in depth. Thesizes for single bubble sonoluminescing (SBSL) stable bubbles are lowerand ranges are given in the Table 2 below (estimated from FIGS. 1, 2,and 3 of Yasui, 2002):

TABLE 2 F, kHz 20 140 1,000 D_microns 0.2-200 0.6-25 0.2-6

For efficient delivery into the follicles with cavitation bubbles, thereis an optimal cavitation bubble size range. Strong cavitational shockwaves are needed, which are generated with relatively large bubbles.However, if the bubble size is too large, it produces strong shockwaves, which may compress the skin, reducing the pore size, and reducingefficient delivery to a target (e.g., sebaceous gland, follicle). Forexample, if the bubble size is much larger than the follicle opening,the resulting shock waves compress not only the pore opening, but alsothe skin surrounding the pore opening. This inhibits efficient deliveryinto the follicle opening. Desirably, bubble sizes should be about thesame size as the target pore. Typical pore sizes of follicles on humanskin are estimated to be in the range of 12-300 microns. Thus, anadvantageous ultrasound frequency range is 20 kHz to 500 kHz. In otheralternatives, the application of ultrasound frequency is in the range of20 kHz to 100 kHz, or 20 kHz to 60 kHz or even 30 kHz to 50 kHz. Thedesired power density is estimated to be in the range of 0.5-50 W/cm².This is sufficient to generate cavitation bubbles in the desired sizerange.

“Immersion cavitation” as used herein is defined as formation andcollapse of cavitation bubbles due to the ultrasound energy within thefluid formulation.

In light of the above description, there is also provided a method offacilitating delivery of light absorbing materials into a hair follicleby selecting characteristics for the acoustically created microjets tocreate bubbles in the formulation about the same size as the hairfollicle pore. Selecting the characteristics permits the bubbles to beabout the same size as a terminal follicle, a vellus follicle, or asebaceous follicle. In another alternative implementation in light ofthe above description, there is also provided a method of facilitatingdelivery of light absorbing materials into a hair follicle by selectingcharacteristics for the low frequency ultrasound induced cavitation forcreating bubbles in the formulation about the same size as the hairfollicle. In one implementation, the hair follicle is a terminalfollicle. In another implementation, the hair follicle is a vellusfollicle. In still another implementation, the hair follicle is asebaceous follicle. In still other aspects the ultrasound createdmicrojects or low frequency ultrasound induced cavitation occurs in theformulation between about 50 microns to about 100 microns of the surfaceof the skin.

In another embodiment, there is also provided a method of treating orameliorating a follicular skin disease of a subject. The method includesthe step of exposing the subject's skin to a formulation comprising asub-micron particle comprising a light absorbing material to a subject'sskin. Next, there is a step of facilitating delivery of said materialfrom the skin into a hair follicle by low frequency ultrasound inducedcavitation within the formulation near the surface of the skin adjacentto the hair follicle. Thereafter, exposing said sub-micron particle toenergy activation, thereby treating the follicular skin disease. In onealternative, there is also a step of exposing by placing a volume of theformulation in a container so that the formulation is in contact withthe subject's skin. Still further, there is also a step of facilitatingthe method by placing an ultrasound applicator into the container andimmersed in the formulation.

In still another embodiment, there is provided a method of facilitatingdelivery of a light absorbing material to a target volume within theskin of a subject. The method includes the step of topically applying aformulation comprising a light absorbing material to a subject's skin todeliver the material to a reservoir within the target volume of theskin. Next, there is a step of facilitating delivery of said material toa target volume within the skin of the subject substantially via atransfollicular pathway. Next, there is a step of exposing the lightabsorbing material to a series of light pulses to heat the material andthermally damage the target volume to achieve a therapeutic effect. Inone alternative, the formulation has an optical density of between5-500. In another alternative, the formulation has an optical density ofabout 75. In still another alternative, the formulation has an opticaldensity of about 125. In still another alternative, the formulation hasan optical density of about 250. In one aspect, the target volume is thesebaceous gland. In another aspect, the target volume is within thefollicle beneath the skin.

In still another aspect, the facilitating step includes an immersioncavitation step. In another alternative, there is provided a step offacilitating delivery into a sebaceous gland using immersion ultrasound.In one alternative, the facilitating step includes forming microjetswithin the formulation. In one aspect, the facilitating using ultrasoundproduces cavitation within a formulation and about 50 to 100 microns ofthe surface of the skin. In any of the above described methods, there isalso the step of acoustically cavitating the formulation for selectivelyfacilitating delivery of said particles in the formulation into asebaceous gland primarily through the corresponding hair follicle.Thereafter, there is the step of irradiating said particles with lightto treat the follicular skin disease. In one embodiment, the particlesare sized from about 1 micron to about 5 microns. In another aspect, theparticles are sized to enter into and along a follicle pore. In stillother embodiments, the particles are between about 50 nm about 250 nm indiameter. In another embodiment, the particles are nanoshells.

Energy (Light) Activation

After the topical application and facilitated delivery (e.g., bymechanical agitation, ultrasound), the top of the skin is wiped off toremove the residual light absorbing material. This is followed by energy(light) irradiation. The light is absorbed by the material inside thefollicle or sebaceous gland leading to localized heating. The lightsource depends on the absorber used. For example, for nanoshells thathave broad absorption spectrum tuned to 800 nm resonance wavelength,sources of light such as 800-nm, 755-nm, 1,064-nm or intense pulsedlight (IPL) with proper filtering can be used. In one aspect, thenanoparticles in a suspension have a peak absorption between 700 and1,100 nm wavelength of light. Such pulsed laser irradiation leads tothermal damage to the tissue surrounding the material. In one aspect,the light energy has a fluence of less than about 100 J/cm2. Damage toinfundibular follicular stem cells and/or sebaceous glands leads toimprovement in the follicular conditions, such as acne. Such methods canbe used not only for particulates in suspensions but for small dissolvedmolecules in solution as well. These can include pharmaceutical drugs,photodynamic therapy (PDT) pro-drugs, or PDT drugs.

Suitable energy sources include light-emitting diodes, incandescentlamps, xenon arc lamps, lasers or sunlight. Suitable examples ofcontinuous wave apparatus include, for example, diodes. Suitable flashlamps include, for example pulse dye lasers and Alexandrite lasers.Representative lasers having wavelengths strongly absorbed bychromophores, e.g., laser sensitive dyes, within the epidermis andinfundibulum but not sebaceous gland, include the short-pulsed red dyelaser (504 and 510 nm), the copper vapor laser (511 nm) and theQ-switched neodymium (Nd):YAG laser having a wavelength of 1064 nm thatcan also be frequency doubled using a potassium diphosphate crystal toproduce visible green light having a wavelength of 532 nm. In thepresent process, selective photoactivation is employed whereby an energy(light) source, e.g., a laser, is matched with a wave-length to theabsorption spectrum of the selected energy activatable material,preferably a chromophoric agent.

It is easier to achieve a high concentration of the light absorbingmaterial in the infundibulum than the sebaceous duct and the gland,which provide a higher resistance to material transport. The follicleincluding the sebaceous gland can be irreversibly damaged just relyingon light absorption principally but the material in the infundibulum.This is mediated through damage to the keratinocytes in the follicularepithelium. Also, with higher energy pulses can be used to extend thethermal damage to include the stem cells in the outer root sheath, thebulge, as well as the outside periphery of the sebaceous glands.However, such high energy should not lead to undesired side effects.Such side effects can be mitigated by use of cooling of the epidermisand also use of longer pulse durations, on the order of severalmilliseconds, extending up to 1,000 ms.

Thermal alteration of the infundibulum itself with only limitedinvolvement of sebaceous glands may improve acne. Appearance of enlargedpores on the face is a common issue for many. This is typically due toenlarged sebaceous glands, enlarged infundibulum, as well as enlargedpore opening. Heating of tissue, especially collagen, shrinks thetissue. The delivery of nanoshells and thermal targeting of the same inthe infundibulo-sebaceous unit that includes the upper, lowerinfundibulum, as well as the sebaceous gland, will improve theappearance of enlarged pores.

Energy Absorbing Material Formulations

The invention provides compositions comprising light/energy absorbingmaterials for topical delivery. In one embodiment, a particle in thecomposition is a nanoparticle comprising a silica core and a gold shell.In still another embodiment, a compound of the invention comprises asilica core and a gold shell (150 nm). In another embodiment, nanoshellsused are composed of a 120 nm diameter silica core with a 15 micronthick gold shell, giving a total diameter of 150 nm.

The nanoshell is covered by a 5,000 MW PEG layer. The PEG layer preventsand/or reduces nanoshell aggregation, thereby increasing the nanoshellsuspensions stability and shelf-life. In one embodiment, thenanoparticle has a diameter of about 50 to about 250 nm. In someembodiments, the ratio of the shell diameter to the core diameter of theparticles used herein are between about 1.5 to about 2.0. In anotheraspect, the particles in a formulation comprise from about 0.5% to about2% of the formulation.

Nanoparticles of the invention exhibit Surface Plasmon Resonance, suchthat Incident light induces optical resonance of surface plasmons(oscillating electrons) in the metal. The Wavelength of peak absorptioncan be “tuned” to the near-infrared (IR) portion of the electromagneticspectrum. The submicron size of these nanoparticles allows their entryinto the infundibulum, sebaceous duct and sebaceous gland of theepidermis, and minimizes their penetration of the stratum corneum. Inparticular embodiment, selective transfollicular penetration ofnanoparticles ˜150-350 nm in diameter is achieved. In one aspect, thereis provided a method of treating or ameliorating a follicular skindisease of a subject. There is a step of topically applying aformulation comprising a sub-micron particle comprising a lightabsorbing material to a subject's skin. Next there is a step ofdelivering said formulation into one or more sebaceous glandssubstantially via a transfollicular pathway. Next, there is a step ofexposing said sub-micron particle to energy activation, thereby treatingthe follicular skin disease. In one aspect, a portion of the stratumcorneum within the portion of the skin exposed to the delivering stepremains intact. Still further, the delivering step is completed using animmersion ultrasound step whereby the portion of the stratum corneumwithin the portion of the skin exposed to the delivering step remainsintact.

If desired, light/energy absorbing materials are provided in vehiclesformulated for topical delivery. In one embodiment, a composition of theinvention is formulated with agents that enhance follicular delivery,including but not limited to, one or more of ethanol, isopropyl alcohol,propylene glycols, surfactants such as polysorbate 80, Phospholipon 90,polyethylene glycol 400, and isopropyl adipate. In other embodiments, acomposition of the invention is formulated with one or more thickeningagents, including but not limited to, hydroxypropylcellulose (HPC) andcarboxymethyl cellulose (CMC), to enhance handling of the formulations.

Wetting agents, emulsifiers and lubricants, such as sodium laurylsulfate and magnesium stearate, as well as coloring agents, releaseagents, coating agents, sweetening and perfuming agents, preservativesand antioxidants can also be present in the compositions.

Liquid dosage forms for topical administration of the compositions ofthe invention include pharmaceutically acceptable emulsions,microemulsions, solutions, creams, lotions, ointments, suspensions andsyrups. In addition to the active ingredient, the liquid dosage formsmay contain inert diluents commonly used in the art, such as, forexample, water or other solvents, solubilizing agents and emulsifiers,such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethylacetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butyleneglycol, oils (in particular, cottonseed, groundnut, corn, germ, olive,castor, peach, almond and sesame oils), glycerol, tetrahydrofurylalcohol, polyethylene glycols and fatty acid esters of sorbitan, andmixtures thereof.

Suspensions, in addition to the active compounds, may contain suspendingagents as, for example, ethoxylated isostearyl alcohols, polyoxyethylenesorbitol and sorbitan esters, microcrystalline cellulose, aluminummetahydroxide, bentonite, agar-agar and tragacanth, and mixturesthereof.

The ointments, pastes, creams and gels may contain, in addition to anactive compound of this invention, excipients, such as animal andvegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulosederivatives, polyethylene glycols, silicones, bentonites, silicic acid,talc and zinc oxide, or mixtures thereof. The term “cream” is artrecognized and is intended to include semi-solid emulsion systems whichcontain both an oil and water. Oil in water creams are water miscibleand are well absorbed into the skin, Aqueous Cream BP. Water in oil(oily) creams are immiscible with water and, therefore, more difficultto remove from the skin. These creams are emollients, lubricate andmoisturize, e.g., Oily Cream BP. Both systems require the addition ofeither a natural or a synthetic surfactant or emulsifier.

The term “ointment” is art recognized and is intended to include thosesystems which have oil or grease as their continuous phase. Ointmentsare semi-solid anhydrous substances and are occlusive, emollient andprotective. Ointments restrict transepidermal water loss and aretherefore hydrating and moisturizing. Ointments can be divided into twomain groups—fatty, e.g., White soft paraffin (petrolatum, Vaseline), andwater soluble, e.g., Macrogol (polyethylene glycol) Ointment BP. Theterm “lotion” is art recognized and is intended to include thosesolutions typically used in dermatological applications. The term “gel”is art recognized and is intended to include semi-solid permutationsgelled with high molecular weight polymers, e.g., carboxypolymethylene(Carbomer BP) or methylcellulose, and can be regarded as semi-plasticaqueous lotions. They are typically non-greasy, water miscible, easy toapply and wash off, and are especially suitable for treating hairy partsof the body.

Subject Monitoring

The disease state or treatment of a subject having a skin disease ordisorder can be monitored during treatment with a composition or methodof the invention. Such monitoring may be useful, for example, inassessing the efficacy of a particular agent or treatment regimen in apatient. Therapeutics that promote skin health or that enhance theappearance of skin are taken as particularly useful in the invention.

Kits

The invention provides kits for the treatment or prevention of a skindisease or disorder, or symptoms thereof. In one embodiment, the kitincludes a pharmaceutical pack comprising an effective amount of alight/energy absorbing material (e.g., a nanoshell having a silica coreand a gold shell (150 nm)). Preferably, the compositions are present inunit dosage form. In some embodiments, the kit comprises a sterilecontainer which contains a therapeutic or prophylactic composition; suchcontainers can be boxes, ampules, bottles, vials, tubes, bags, pouches,blister-packs, or other suitable container forms known in the art. Suchcontainers can be made of plastic, glass, laminated paper, metal foil,or other materials suitable for holding medicaments.

If desired compositions of the invention or combinations thereof areprovided together with instructions for administering them to a subjecthaving or at risk of developing a skin disease or disorder. Theinstructions will generally include information about the use of thecompositions for the treatment or prevention of a skin disease ordisorder. In other embodiments, the instructions include at least one ofthe following: description of the compound or combination of compounds;dosage schedule and administration for treatment of a skin conditionassociated with acne, dermatitis, psoriasis, or any other skin conditioncharacterized by inflammation or a bacterial infection, or symptomsthereof; precautions; warnings; indications; counter-indications;overdosage information; adverse reactions; animal pharmacology; clinicalstudies; and/or references. The instructions may be printed directly onthe container (when present), or as a label applied to the container, oras a separate sheet, pamphlet, card, or folder supplied in or with thecontainer.

The recitation of a listing of chemical groups in any definition of avariable herein includes definitions of that variable as any singlegroup or combination of listed groups. The recitation of an embodimentfor a variable or aspect herein includes that embodiment as any singleembodiment or in combination with any other embodiments or portionsthereof.

The following examples are provided to illustrate the invention, not tolimit it. those skilled in the art will understand that the specificconstructions provided below may be changed in numerous ways, consistentwith the above described invention while retaining the criticalproperties of the compounds or combinations thereof.

Laser Hair Removal

The invention features compositions and methods that are useful forlaser hair removal, particularly in light colored hair. In laser hairremoval, a specific wavelength of light and pulse duration is used toobtain optimal effect on a targeted tissue with minimal effect onsurrounding tissue. Lasers can cause localized damage to a hair follicleby selectively heating melanin, which is a dark target material, whilenot heating the rest of the skin. Because the laser targets melanin,light colored hair, gray hair, and fine or thin hair, which has reducedlevels of melanin, is not effectively targeted by existing laser hairremoval methods. Efforts have been made to deliver various lightabsorbing materials, such as carbon particles, extracts from squid ink,known commercially as meladine, or dyes into the follicle. These methodshave been largely ineffective.

The present invention provides microparticles in a suspension form thatis topically applied after skin preparation as delineated herein above.In particular, the skin is prepared by epilation of the hair shaft andlight absorbing materials are delivered to the hair follicle.Preferably, the formulation is optimized for follicular delivery withmechanical agitation for a certain period of time. After wiping off theformulation from the top of the skin, laser irradiation is performed,preferably with surface cooling. The laser is pulsed, with pulseduration approximately 0.5 ms-400 ms or, alternatively, from 0.5ms-1,000 ms using a wavelength that is absorbed by the particle or thenanoshells. This method will permanently remove unpigmented or lightlypigmented hair by destroying the stem cells and other apparatus of hairgrowth which reside in the bulge and the bulb area of the follicle.

The practice of the present invention employs, unless otherwiseindicated, conventional techniques of molecular biology (includingrecombinant techniques), microbiology, cell biology, biochemistry andimmunology, which are well within the purview of the skilled artisan.Such techniques are explained fully in the literature, such as,“Molecular Cloning: A Laboratory Manual”, second edition (Sambrook,1989); “Oligonucleotide Synthesis” (Gait, 1984); “Animal Cell Culture”(Freshney, 1987); “Methods in Enzymology” “Handbook of ExperimentalImmunology” (Weir, 1996); “Gene Transfer Vectors for Mammalian Cells”(Miller and Calos, 1987); “Current Protocols in Molecular Biology”(Ausubel, 1987); “PCR: The Polymerase Chain Reaction”, (Mullis, 1994);“Current Protocols in Immunology” (Coligan, 1991). These techniques areapplicable to the production of the polynucleotides and polypeptides ofthe invention, and, as such, may be considered in making and practicingthe invention. Particularly useful techniques for particular embodimentswill be discussed in the sections that follow.

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how tomake and use the assay, screening, and therapeutic methods of theinvention, and are not intended to limit the scope of what the inventorsregard as their invention.

EXAMPLES Example 1

Topical Delivery of Nanoshells to the Follicular Epithelium for theTreatment of Follicular Diseases

An example of massage as a mechanical means of follicular delivery isdescribed. Nanoshell suspension tuned to 800-nm was massaged in anepilated pig skin in an in vivo live pig. Laser energy with parallelcontact cooling was applied after wiping off the suspension on the topof the skin. A biopsy was taken, and routine histology was performed. Amicrograph of the histology is shown at FIG. 1. Thermal damage to thefollicular epithelium and part of the sebaceous gland is noted. Suchdamage is useful for the treatment of follicular diseases, such as acneor for improving the appearance of oily skin of a subject.

One exemplary method for the treatments above includes the step oftopically applying a formulation comprising a sub-micron particlecomprising a light absorbing materials to a subject's skin. Next, thereis a step of facilitating delivery of said materials to a hair follicle,sebaceous gland, sebaceous gland duct, or infundibulum of the skin bymechanical agitation, acoustic vibration, ultrasound, alternatingsuction and pressure, or microjets. Thereafter, there is the step ofexposing said sub-micron particle to energy activation, thereby treatingthe follicular skin disease.

Example 2

Topical Delivery of Nanoshells to the Follicular Epithelium for LaserHair Removal

In preparation for laser hair removal, a pig flank was epilated bywaxing Skin was subsequently heated, and a vacuum was applied to emptythe follicular contents of the skin. Silica core: gold shellmicroparticles, of approximate dimensions of 0.150 micrometers diametercoated with PEG were then delivered by massaging Skin was wiped toremove the material from the top of the skin. This was followed bypulsed laser irradiation at 800 nm. Samples were excised, fixed informalin, and processed via routine histology (H&E staining). Thermalinjury to the follicular structure was noted via histology.

Example 3

Light-Pulse Induced Pressure Pulse Facilitated Delivery

A formulation containing a light-absorbing material is applied on top ofskin. This is moved into the infundibulum of the infundibulo-sebaceousunit by methods known in the art, including but not limited to, passivediffusion, heating, mechanical assistance such as pressure pulsing,vibration, acoustic coils, ultrasound, nozzles or a combination of theabove. Then, pulses of light are applied with a handpiece with anintegrated cooling plate that can be pressed on to the skin. The firstpulse(s) of light heat the material, resulting in expansion, with orwithout steam bubble formation. A pressure pulse is thereby created.Pressure is applied to the skin by the plate during the pressure pulse.Because the pressure cannot escape from the skin, the material flowsthrough low resistance channels within the skin, such as the sebaceousgland duct, to reach the sebaceous gland. This pulse typically has shortpulse duration, e.g., 1 ns-1 ms, preferably, 10 ns-100 microseconds, tomaximize the magnitude of the pressure pulse, for example, through steambubble formation. Once the material is within the target sebaceousgland, light is applied with a pulse duration and radiant exposureappropriate to the size of the sebaceous glands being targeted. Thelight absorbing material is heated, causing thermal damage to thesebaceous gland, thus inactivating it, and causing improvement in acnevulgaris and other follicular diseases and conditions associated withthe presence or activity of sebaceous glands.

In a related approach, a train of low-energy laser pulses, 1 microsecondor less in pulse duration, preferably in the acoustic range for pulserepetition rate, is used to activate the particles. This activationviolently ‘stirs’ the particles, some of which will be propelled fromthe infundibulum into the sebaceous glands.

Example 4

Use of Ultrasound to Deliver Light Absorbing Material to the Follicleand Sebaceous Glands

Pig ear skin was kept frozen. Before the experiment, it was thawed. Hairwas epilated with waxing and a piece of the pig ear with skin facing upwas placed at the bottom of a cup. It was filled with formulation of150-nm diameter silica-core/gold-shell nanoshells (Sebacia, Inc.,Duluth, Ga.) with an optical density of approximately 250. A Sonics, 20kHz device horn was immersed into the formulation so that the distancebetween the far surface of the horn at the top of the skin wasapproximately 5-mm. The horn diameter was 13 mm and the power output wasapproximately 6 W. Thus, the power density during the on-time was 4.5W/cm2. The device was turned on with 50% duty cycle, with the on-timeand off-time per cycle of 5 s and 5 s, respectively. Four cycles wereapplied. After wiping the skin to remove excess formulation, the skinwas irradiated with laser light at 800-m wavelength with a 9 mm.times.9mm spot, approximately 50 J/cm2 total radiant exposure, and 30-ms pulseduration.

The skin was observed via a dissecting microscope and photographs weretaken (FIG. 2). Cuts perpendicular to the skin surface were made throughfollicle openings and the cut surface was observed through an opticalmicroscope (FIG. 3). Some samples were placed in 10% buffered formalinsolution and observed via routine histology (FIG. 4).

The skin was intact and unperturbed except punctuate dots were noted onthe follicle openings (FIG. 2). Upon cutting and observing through amicroscope, the presence of dark nanoshells was noted within thefollicle infundibulum, as well as in the sebaceous glands (FIG. 3). Nonanoshells were seen in the epidermis or the dermis surrounding thefollicles. Similarly, histology showed thermal damage to the follicularinfundibulum and the sebaceous glands (FIG. 4). There was no or minimaldamage to the epidermis and the dermis surrounding the follicles.

In one alternative aspect, in an method employing an ultrasound hornused for immersion ultrasound, the ultrasound horn face peak-to-peakamplitude displacement is in the range of 0.5 to 30 microns.

In still other aspects, there is provided a sub-micron particle size isselected for passage through the hair follicle and into a sebaceousgland of the hair follicle. In one embodiment, the hair follicle is aterminal follicle. In another embodiment, the hair follicle is a vellusfollicle. In still another embodiment, the hair follicle is a sebaceousfollicle. In still further implementations of the inventive methodsdescribed herein, the sub-micron particle size is between about 0.01microns to about 1.0 microns. In still another exemplary implementation,the sub-micron particle size is between about 0.05 to about 0.25microns.

Example 5

Ultrasound Facilitated Delivery

A transducer from APC International of Mackeyville, Pa. was driven by asinusoidal wave of 300 Vp-p from a waveform generator and an amplifierwith 500 Ohm source impedance. A formulation of 250 OD (F78, Sebacia,Inc.) containing the 150 nm diameter silica core: gold shell was placedtopically on epilated pig ear skin. This was followed by wiping of thetop surface and laser irradiation with Lumenis LIGHTSHEER at or about800 nm. The skin temperature was noted after the ultrasound applicationand did not exceed 41. degree. C.

Significant accumulation of the nanoshells in the follicles was noted(FIG. 5). Vertical cuts were made through follicles and the cut surfaceswere observed under a microscope. An exemplary follicle is shown in FIG.6. A significant accumulation of nanoshells inside and outside theinfundibulum is noted.

Histological analysis of a sample is shown in FIG. 7. Localized thermaldamage to the follicle including thermal damage to the sebaceous glandsis observed (FIG. 7).

Example 6

Human Clinical Efficacy Demonstrated in Back Acne

The efficacy of nanoshell topical delivery followed by laser treatmentwas evaluated in a clinical study of back acne. Nanoshells weretopically applied to the back of each subject and laser treatment wasinitiated as described herein above. This treatment regimen wasadministered twice to each subject. Results were evaluated twelve weeksfollowing the second treatment. Efficacy was determined by weightedinflammatory lesion counts. Results are shown in FIG. 8. This study ofback acne study indicates that the treatment regimen was clinicallyeffective.

Example 7

Human Clinical Efficacy Demonstrated in Sebaceous Gland Damage

IRB approved human clinical studies have been carried out in seventeensubjects (6 males, 11 females) with acne. The subjects range in age from18-40 years (mean 24 years) phototype I-IV. Treatment was carried out ona 1 square inch area behind ear (sebaceous follicles). Nanoshells weredelivered followed by laser treatment, where the laser was tuned to thenanoshell's absorption peak (40-50 J/cm2, 30-ms, 9.times.9 mm,LIGHTSHEER (at or about 800 nm)). Therapeutic efficacy washistologically evaluated in 31 biopsies, where 4-7 follicles werepresent in each biopsy. A 4 mm punch biopsy was taken, seriallysectioned, and damage to sebaceous follicle was visualized by H&Estaining Pain, erythema, edema minimal. Localized damage was observed in.about.60% of sebaceous follicles. In some specimens, destruction of theentire sebaceous gland was observed. The depth of thermal damage infollicles was on average 0.47 mm (maximum 1.43 mm). No collateral damageto epidermis or dermis was observed. In-vivo histology study damage toinfundibulum, bulge and sebaceous glands was observed after treatment.

Example 8

Ultrasound Facilitated Delivery of Photodynamic Therapy (PDT) withAminolevulinic Acid (ALA)

In experiments with ultrasound, the follicle provided easier access fordelivery of light absorbing materials than the stratum corneum. This maybe due to a differential in the transport rates into the stratum corneumand the follicle. This difference can be exploited to facilitateselective delivery of smaller molecules. This approach can be used foreither chromophores in a photothermal treatment regimen or forphotodynamic therapy with compounds or prodrugs leading to photodynamiceffect. For example, convention acne therapies involving ALA-PDTtreatment require long incubation times (on the order of 3-4 hours) todeliver sufficient concentration of ALA to the sebaceous glands toachieve the desired clinical efficacy.

This treatment results in significant adverse side effects, includingepidermal crusting, pain, and long-lasting redness. This extendedincubation period results in the delivery of ALA to non-target areas ofthe epidermis and the dermis. Ultrasound-assisted delivery can beaccomplished without these long incubation periods, while stillachieving sufficient concentrations in the target infundibulo-sebaceousunit. Because the long incubation period is eliminated with ultrasounddelivery, little ALA is delivered to the non-target epidermis anddermis. After ultrasound delivery, the ALA formulation can be removedfrom the skin surface. The light irradiation is performed oncesufficient time has passed to ensure that concentrations of thephotoactive material have reached adequate levels in the target volume.In photothermal treatments, pulsed laser irradiation can be initiatedsoon after delivery.

In another embodiment, materials (compounds) of interest are attached tomicroparticles and delivered to the target volume. Light irradiation maybe used to disassociate the material, leading to its diffusion andsubsequent action. Formation of cavitation bubbles is facilitated by thepresence of nanoparticles that “seed” bubble formation. Also, deliverycan be facilitated by the use of volatile components such as ethanol.

Example 9

Formulations

Various nanoshells formulation were tested in an ex vivo skin model. Thecomponents tested were designed to enhance delivery into follicles.Formulation constituents were ethanol, isopropyl alcohol, propyleneglycols, surfactants such as polysorbate 80, Phospholipon 90,polyethylene glycol 400, isopropyl adipate. Compatibility of theseamongst each other was tested. Three classes were identified:hydrophilic, lipophilic, and liposomal. The absorption coefficient ofthe formulation is suggested to be in the range of 10 to 1,000 inversecm. Four example formulations were tested in an in vivo pig skin model;the compositions are as in Table 3 below showing four of theformulations tested in a human back acne study.

TABLE 3 Components F74 F76 F78 F80 PEGylated nanoshell suspension 12%25% 25% 65% in water (Optical density ~1,100-1,200) Ethyl Alcohol 190proof 73% 55% 54% 20% Propylene Glycol 5% 10% 5% Polysorbate 80 1% 9% 1%9% Benzyl Alcohol 9% 1% 1% Diisopropyl Adipate 20% Total 100% 100% 100%100%

The desired effects from selective photothermolysis of sebaceous glandsusing any one or more of the above described delivery techniques,compositions or formulations can be enhanced by choosing an optimaltreatment interval by retreating cells and tissue when they are mostvulnerable to repeated thermal injury. The desired effects fromselective photothermolysis of sebaceous glands using one or acombination of the above can be enhanced by choosing an optimaltreatment interval. In one aspect, the treatment interval is selected byre-treating cells and tissue when they are most vulnerable to repeatedthermal injury. In one aspect, the second or subsequent treatment occursone, two, three, four, five or six days after the initial or just priortreatment. In one aspect, the interval between second and subsequent orthe just prior treatment is the same or, optionally, different. In oneaspect, the second or subsequent treatment occurs between 4-14 daysafter the previous treatment.

In one specific aspect, there is provided a mechanism of acne treatmentthrough delivery of light absorbing particles into the sebaceousfollicles selectively followed by pulsed laser irradiation that causesselective heating. Cell death occurs primarily due to heat fixation orprotein denaturation though some occurs via apoptosis and accidentalcell death. It is desired to achieve a high level of injury in onesingle treatment but without collateral damage and side effects. Due tovarious reasons including limited delivery of the particles possible inone treatment, the injury is limited and other factors a singletreatment may not lead to complete resolution of acne. Second oradditional subsequent treatments, given during the proper treatmentinterval, would likely enhance the clinical improvement and durabilityof the therapy.

FIG. 9 illustrates in a general way the biologic response of cells andtissue to thermal injury as a function of time since thermal injuryoccurred. Cells are most vulnerable to further damage after 4-14 dayspost-injury. Prior to day 4, body's response involves expression ofvarious molecules including heat shock proteins which provide a cloak ofprotection. The heat shock protein peaks at 34 hours post treatment andis much reduced at 72 hours (See Laubach, et al., 2006, Skin Responsesto Fractional Photothermolysis, Lasers in Surgery and Medicine LaubachHans-Joachim, Tannous Zeina, Anderson R. Rox, Manstein Dieter, Lasers inSurgery and Medicine, Vol. 38, Issue 2, pages 142-149, February 2006,incorporated herein by reference.) Also, in the same work, Laubachshowed that the cells showing loss of viability are almost undetectableat day 7. Thus at about day 7, two effects are noted: (1) the cloak ofprotection due to HSP is minimal and (2) the non-viable cells due to thetreatment have almost disappeared.

These two effects in conjunction with other factors lead to variousaspects of the present invention to provide for an optimal time-windowto perform the next treatment, or a series of subsequent treatments,depending upon patient need or desired clinical outcome. FIG. 9 alsoshows that between 4-14 days, the cells with sub-lethal injury arerepairing and there is proliferation of new cells due to the thermalinjury. Both processes are active in this interval and hence, a newtreatment would damage the cells in these two cycles. While desiring notto be bound by theory, it is believed that a treatment timed to thisinterval would enhance the treatment effect.

It is also possible that the window for the next treatment starts at 24hours—a higher energy could do permanent damage to the already damagedtissue including cells. Also, the sebum is expelled at around 24 hoursand the infundibulum would be most clear at that time. This would allowfor the most efficient delivery during the next treatment. Also, theremay be residual particles present from the previous treatment and atreatment at 24 hours would target the previously delivered particles aswell as the newly delivered with the high efficiency afforded by theempty infundibulum.

This first set of treatments will typically consist of 1-5 treatments.This is expected to give a treatment response of 8-12 months. After thisperiod, further treatment is necessary to obtain remission in acnesymptoms. This can be obtained by giving another set of treatments,again with a similar interval of 4-14 days.

FIG. 10 is a flow chart of an exemplary method 100 of providing therapybased on a desired response interval. First at step 105, is the topicalapplication of a formulation to the skin of the patient at the treatmentsite. Next, at step 110, there is the step of facilitating the deliveryof the materials into the skin of the treatment site. Thereafter, is theexposure of the particles in the treatment site to an appropriate energyactivation source (step 115). After this initial treatment (step 115),the user then waits for the desired response interval to elapse. Theresponse interval may be measured in a variety of ways. In one aspect,the treatment interval is based on time (as in the days indicated onFIG. 9). In one aspect, the treatment interval is based on the state ofinitial, partial or complete repair of specific tissue or combinationsof tissue (as detailed in FIG. 9). In still another aspect, thetreatment interval is based on the state of the initial, partial orcomplete biologic response of specific tissue or combinations of tissue(as detailed in FIG. 9).

If the answer to step 120 is “NO” then the user waits until the responsetime has elapsed (step 125).

If the answer to step 120 is “YES” then the user determines whether thetreatment plan or clinical situation calls for an additional treatment.If an additional treatment is to be delivered, (Answer to step 130 is“YES”) then the user proceeds to perform steps 105, 110 and 115 asdesired based on any of the above described techniques. The second orsubsequent formulation, method or methods of facilitating delivery aswell as type and exposure of energy activation may be the same ordifferent from the initial or just previous performance of the method.

If the answer to step 130 is “NO” then the user determines whether thetreatment plan or clinical situation does not call for an additionaltreatment. The treatment is concluded (step 135).

Other Embodiments

The examples and illustrations included herein show, by way ofillustration and not of limitation, specific embodiments in which thesubject matter may be practiced. In one aspect, the operation of thedelivery device for the delivery of a delivery fluid is the desiredtherapy. In this case, the operation of the delivery device is acomplete treatment operation. In another aspect, the operation of thedelivery device for the delivery of a delivery fluid precedes or followsanother treatment or another desired therapy. In this case, theoperation and use of the delivery device is one part of a multi-parttherapy. In one specific example of a multiple part therapy is the useof the delivery system to deliver a fluid, a formulation particles,shells, pharmaceuticals, liposomes, other treatment agents orpharmacologic materials onto, into or within a structure within atreatment or delivery site followed by a further treatment of thedelivery or treatment site. In one specific example the furthertreatment is providing an activating energy to a fluid, a formulation ora pharmacologic material. Exemplary fluids, formulations and treatmentsare described in U.S. Pat. Nos. 6,183,773; 6,530,944; U.S. PatentApplication Publication No. US 2013/0315999 and U.S. Patent ApplicationPublication No. US 2012/0059307, each of which is incorporated herein inits entirety. Additionally or optionally, one or more of the deliverydevice operating parameters, and/or methods of use of the deliverysystem described herein may be modified based upon one or morecharacteristics of the delivery fluid, a component of the delivery fluidor a particle within the delivery fluid being used.

From the foregoing description, it will be apparent that variations andmodifications may be made to the invention described herein to adopt itto various usages and conditions. Such embodiments are also within thescope of the following claims.

The recitation of a listing of elements in any definition of a variableherein includes definitions of that variable as any single element orcombination (or subcombination) of listed elements. The recitation of anembodiment herein includes that embodiment as any single embodiment orin combination with any other embodiments or portions thereof.

What is claimed is:
 1. A method of at least one of treating andameliorating acne vulgaris in a subject, the method comprising: a. afirst phase of treatment, said first phase of treatment comprising: i.topically applying a first formulation comprising plasmonicnanoparticles in a hydrophilic solution to a subject's skin of a face oran upper trunk, said first formulation having an optical density ofbetween about 5 and about 500; ii. mechanically agitating said firstformulation on said skin to facilitate delivery of said nanoparticles toat least one of the group of a hair follicle, a sebaceous gland, asebaceous gland duet, and an infundibulum of the skin; and iii.irradiating said nanoparticles with light having a wavelength betweenabout 700 and about 1,100 nm that is absorbed by said nanoparticles,thereby heating said skin local to said nanoparticles for at least oneof treating and ameliorating acne vulgaris; and b. a second phase oftreatment, said second phase of treatment comprising: i. between about23 hours and 14 days after said irradiating step of said first phase oftreatment: a. topically applying a second formulation comprising saidnanoparticles to said subject's skin, said second formulation having anoptical density of between about 5 and about 500; b. mechanicallyagitating said second formulation on said skin to facilitate delivery ofsaid nanoparticles to at least one of the group of a hair follicle, asebaceous gland, a sebaceous gland duct, and an infundibulum of theskin; and c. irradiating said nanoparticles with light having awavelength between about 700 and about 1,100 nm that is absorbed by saidnanoparticles, thereby heating said skin local to said nanoparticles forat least one of treating and ameliorating acne vulgaris.
 2. The methodof claim 1 further comprising a third phase of treatment after saidsecond phase of treatment comprising, between about 23 hours and 14 daysafter said second phase of treatment, repeating the topically applying,mechanically agitating and irradiating steps of the second phase oftreatment.
 3. The method of claim 2 further comprising a fourth phase oftreatment comprising, between about 8 and 12 months after said thirdphase of treatment, repeating the topically applying, mechanicallyagitating and irradiating steps of the second phase of treatment.
 4. Themethod of claim 3 further comprising a fifth phase of treatment, betweenabout 23 hours and 14 days after said fourth phase of treatment,repeating the topically applying, mechanically agitating and irradiatingsteps of the second phase of treatment.
 5. The method of claim 4 furthercomprising a sixth phase of treatment, between about 23 hours and 14days after said fifth phase of treatment of claim 4, repeating thetopically applying, mechanically agitating and irradiating steps of thesecond phase of treatment.
 6. The method of claim 2 wherein the thirdphase of said topically applying, mechanically agitating and irradiatingsteps is performed about 4 days after said second phase of treatment. 7.The method of claim 2 wherein the third phase of said topicallyapplying, mechanically agitating and irradiating steps is performedabout 5 days after said second phase of treatment.
 8. The method ofclaim 2 wherein the third phase of said topically applying mechanicallyagitating and irradiating steps is performed about 6 days after saidsecond phase of treatment.
 9. The method of claim 1 further comprising,between about 23 hours and 14 days after said second phase of treatment,making a clinical evaluation of whether said subject needs further atleast one of treating and ameliorating acne vulgaris, and if saidsubject needs further treatment repeating the topically applying,mechanically agitating and irradiating steps before 14 days have lapsedsince said second irradiating step of the second phase of treatment. 10.The method of claim 1 wherein the nanoparticles are within a sebaceousgland during the irradiating steps.
 11. The method of claim 1 whereinthe nanoparticles are within an infundibulum involved in the acnevulgaris.
 12. The method of claim 1 wherein the nanoparticles have asize that is between about 0.05 to about 0.25 microns.
 13. The method ofclaim 1 wherein the nanoparticles are coated with PEG.
 14. The method ofclaim 1 wherein the nanoparticles are nanoshells.
 15. The method ofclaim 1 wherein energy activation of the nanoparticles is accomplishedwith a pulsed laser light that delivers light energy at a wavelengththat is absorbed by the nanoparticles.
 16. The method of claim 1 whereinthe first and second formulations comprise the same formulation.
 17. Themethod of claim 1 wherein the nanoparticles comprise at least one ofgold and silver.
 18. The method of claim 1 wherein the nanoparticles aregold nanoshells with a peak absorption between 700 and 1,100 nmwavelength of light.
 19. A method of at least one of treating andameliorating acne vulgaris in a subject, the method comprising: a.topically applying a first application of a formulation comprising oneor more plasmonic nanoparticles in a hydrophilic solution comprising atleast one of the group consisting of gold, silver, and combinationsthereof to a skin structure of a face or an upper trunk with acnevulgaris; b. facilitating delivery of said nanoparticles to said skinstructure by mechanical agitation; c. irradiating said nanoparticleswith light having a wavelength that is absorbed by said nanoparticles,thereby heating the localized environment of said nanoparticles for atleast one of treating and ameliorating said acne vulgaris; and d.between about 4 and 6 days after said irradiating step, repeating saidtopically applying, facilitating and irradiating steps to the skinstructure for a second application.
 20. The method of claim 19 in whichsaid skin structure comprises at least one member of the groupconsisting of a hair follicle, a sebaceous gland, a sebaceous glandduct, and an infundibulum.
 21. The method of claim 20 further comprisinga third application of said topically applying, facilitating andirradiating steps that is performed between about 4 and 6 days aftersaid second irradiating step.
 22. The method of claim 21 furthercomprising after the third application, repeating said topicallyapplying, facilitating and irradiating steps, between about 4 and 6 daysafter said third irradiating step, for a fourth time.
 23. The method ofclaim 21 further comprising repeating said topically applying,facilitating and irradiating steps between about 8 and 12 months aftersaid third application of said topically applying, facilitating andirradiating steps.
 24. The method of claim 23 further comprisingrepeating said topically applying, facilitating and irradiating steps,between about 4 and 6 days after said third application of saidtopically applying, facilitating and irradiating steps.
 25. The methodof claim 21 wherein the time between the second and third applicationsof said topically applying, facilitating and irradiating steps is about4 days.
 26. The method of claim 21 wherein the time between the secondand third applications of said topically applying, facilitating andirradiating steps is about 5 days.
 27. The method of claim 21 whereinthe time between the second and third applications of said topicallyapplying, facilitating and irradiating steps is about 6 days.
 28. Themethod of claim 19 wherein said nanoparticles are within a sebaceousgland during irradiation.
 29. The method of claim 19 wherein saidnanoparticles are within an infundibulum involved in the acne vulgaris.30. The method of claim 19 wherein said nanoparticles are coated withPEG.
 31. The method of claim 19 wherein said nanoparticles arenanoshells.
 32. The method of claim 19 wherein said nanoparticles have adiameter of about 50 to about 250 nm.
 33. The method of claim 19 whereinthe irradiating step uses light energy at a wavelength range from about700 to about 1,100 nm.
 34. The method of claim 19 wherein theirradiating is achieved using a light energy that has a fluence of lessthan about 100 J/cm2.
 35. The method of claim 19 wherein said skinstructure is prepared for the method by selecting at least one member ofthe group consisting of by heating, by removing the follicular contents,by epilation, and by contacting the follicle pore with adhesivepolymers.
 36. The method of claim 19 wherein the formulation has anoptical density of between 5-500.
 37. The method of claim 19 wherein thenanoparticles are gold nanoshells.
 38. A method for at least one oftreating or ameliorating acne vulgaris in a subject, the methodcomprising: a. a first phase of treatment, said first phase of treatmentcomprising: i. topically applying a formulation comprising nanoparticlesin a hydrophilic solution comprising a light absorbing material to asubject's skin of a face or an upper trunk: ii. facilitating delivery ofsaid nanoparticles to at least one of the group of a hair follicle, asebaceous gland, a sebaceous gland duct, and an infundibulum of the skinby mechanical agitation; and iii. irradiating said nanoparticles withlight having a wavelength that is absorbed by said nanoparticles,thereby heating the localized environment of said nanoparticles for atleast one of treating and ameliorating acne vulgaris b. a second phaseof treatment, said second phase of treatment comprising, between about 4and 6 days after said irradiating step of said first phase of treatment:i. topically applying a formulation comprising said nanoparticlescomprising said light absorbing material to the subject's skin: ii.facilitating delivery of said nanoparticles to at least one member ofthe group consisting of a hair follicle, a sebaceous gland, a sebaceousgland duct, and an infundibulum of the skin by mechanical agitation; andiii. irradiating said nanoparticles with light having a wavelength thatis absorbed by said nanoparticles, thereby heating the localizedenvironment of said nanoparticles for at least one of treating andameliorating acne vulgaris.
 39. The method of claim 38 furthercomprising, between about 4 and 6 days after said second phase oftreatment, repeating the topically applying, facilitating andirradiating steps of the second phase of treatment for a third phase oftreatment.
 40. The method of claim 39 further comprising, between about4 days and 6 days after said third phase of treatment, repeating thetopically applying, facilitating and irradiating steps of the secondphase of treatment for a fourth phase of treatment.